NOTE - I don't want to add negative connotations to female sports and ACL injuries as there are far more sportswomen who haven't done ACL's then who have but there was recently a study that showed clinicians should stop overtreating and where 1 session of high quality education, advice and a self management plan was as effective as 6 physio so that's my angle here.
Education = Compliance = Confidence = Prevention
When I started out with this blog way back in 2009 (!), with my background as a personal trainer/strength and conditioning coach, the focus was purely on physical preparation for football.
If you've been a long term reader than you'll have noticed a gradual shift into the coaching which also adds in tactical, psychological and technical elements of performance and this brings me back to a topic I've covered numerous times before, ACL's.
AFLW 6.0 starts tonight and hopefully we see the best season to date in regards to performance but also limiting ACL injuries.
Even though I don't write much on the physical aspect of football too much these days (when there's new info to provide I do my best to do so), I do still read up on it so here's my latest readings on all things ACL injuries from movement specialists such as Jason Avedesian, Harjiv Singh, Adam Virgile and Rich Clarke.
For a while now my thoughts have been that what we're seeing is not all physically based (strength, range of motion etc) as there's a lot of females in sub-elite and elite sports now but we're still seeing lots of ACL's, even with the vastly improved training that comes playing at those levels.
My local club's women's team implemented one of those ACL prevention programs developed at one of the sports universities and I developed one pretty similar back in 2016 when AFLW started, so I am aware their limitations now looking from lense consisting of the 4 co-actives of sport, not just 1.
Non-contact injuries usually involves a flat footed interaction with the ground + the knee being close to full extension upon landing/deceleration + lateral flexion (side bending) of the torso in the opposite direction that you try to go cascading into an abducted hip, knee valgus and a foot planted in external rotation of the cutting side.
Physically I would aim to develop forefoot (balls of feet) locomotion patterns + trunk rotation and lateral flexion in the direction you intend to cut towards.
Tactically it comes from an error in perception-action coupling error as stimuli must be received, interpreted and organised correctly and efficiently, for the correct movement solution to be found to play against it so the more game experiences you can provide your players in training, the more movement tactical and movement variability they'll develop as every action in football is different so having just 1 solution puts you at great risk in each and every action you perform.
On the back of that you have cognitive load which is comprised of everything going in a game such as decision making on top of your physical and psychological state and it's this divided attention that may be the biggest issue players face as it puts our body and it's movements on a form of autopilot as you can't individually attend to every little thing in the heat of game time.
Things that can be impacted by divided attention include reduced knee flexion at initial contact, increased valgus/knee extension and reduced stability during landing/cutting with a lot of these biomechanical changes coming from the reduced ability to anticipate ground contact and implement protective movement patterns to reduce knee joint loading.
In training settings we have full control over all of these aspects and we mostly train them in isolation so the performance gap is the game play at training mentioned above where physical and psychological demands can also be decreased and built upon if needed.
By using game play during training you are providing your players a greater representative of gamer demands which has far greater transfer than traditional training, and it's not even close.
Coaches always to train like you play but you can't train like you play if you don't play like you play when you train - a bit of a mouthful but you get the point!
Moving to games and what the research shows from those is that game actions like pressing, tackling, being tackled and regaining balance after kicking/landings are the most frequent injury patterns.
It's also important to note that most injuries occur in the first half of games, providing support to the theory that when the game is fast and decision making requirements are at their highest (putting cognitive load through the roof), then players are at their most vulnerable and this backs up my thoughts above that physically we're probably doing more than OK in preparing players but tactically and psychologically we could improve a fair bit.
To dive even deeper in this ACL rabbit-hole, ACL injuries occur within 60 milliseconds of contacts but conscious processing of proprioceptive information doesn't take place for 100 milliseconds, leaving a major gap in the time line where players need to predict what they can and can't do in a safe manner, at that very point in time which again, is developed through increased game play at training and being exposed to a lot of scenarios and situations that require the player to find an infinite amount of solutions that builds movement variability and a more robust system, and studies have shown training environments that use differential learning and a constraints led approach can greatly reduce non-contact ACL injury risk for these very reasons.
Lastly we'll look at sensorimotor performance which is a fancy term but is simply the integration between perceptual sensory input (vision, hearing, touching etc) and the biomechanical movement output (running, jumping, cutting, deceleration etc).
Key attributes here include working memory (team tactics), pattern recognition (us and the opposition), dual tasking (divided attention), visual attention/multiple object tracking (spatial recognition of changing positions of teammates and opposition) and reaction time/processing speed (avoiding on-coming defenders etc), all that needs to be completed in milliseconds (60 of them if you remember from above!).
If players are lacking in some or all of these area's they'll often be out of position tactically and physically and then attempt to fix that by using solutions they probably haven't rehearsed before, and the body isn't quite ready for there and then. By being able to predict what will happen even slightly ahead of time, the body can perform movements and actions that they have processed are already safe to perform.
I'll pull this up here but if you have any questions, thoughts or feedback on this then left me know on the socials and I can confirm whatever you need.
Tigers by 18 tonight.
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